Care N’ Care’s Compliance Program

Care N’ Care (CNC) is committed to complying with all applicable Centers for Medicare & Medicaid Services (CMS) regulations, while upholding the highest ethical business laws, rules, and regulations. Care N’ Care promotes a culture of compliance and is committed to ensuring all employees, Board Members, First Tier, Downstream, and Related Entities (FDRs), and members are responsible for understanding and operating in compliance with applicable law and regulatory guidance. Non-compliance with these laws and failure to report such actions will be subject to further disciplinary action up to, and including, termination.

Care N’ Care contracts with FDRs to perform certain functions on its behalf, however, CNC maintains ultimate responsibility for fulfilling the terms and conditions of its contract with CMS and for meeting the Medicare program requirements with respect to Parts C and D delegated responsibilities. This page provides FDRs with the tools and information to ensure compliance with CMS regulations.

Fraud: Knowingly and willfully executing, or attempting to execute, a scheme or artifice to defraud any health care benefit program or to obtain (by means of false or fraudulent pretenses, representations, or promises) any of the money or property owned by, or under the custody or control of, any health care benefit program. 18 U.S.C. § 1347.

Waste: Waste is the overutilization of services, or other practices that, directly or indirectly, result in unnecessary costs to the Medicare program. Waste is generally not considered to be caused by criminally negligent actions but rather the misuse of resources.

Abuse: Abuse includes actions that may, directly or indirectly, result in: unnecessary costs to the Medicare Program, improper payment, payment for services that fail to meet professionally recognized standards of care, or services that are medically unnecessary. Abuse involves payment for items or services when there is no legal entitlement to that payment and the provider has not knowingly and/or intentionally misrepresented facts to obtain payment.

Fraud, Waste, and Abuse Training and General Compliance Training

The Centers for Medicare & Medicaid Services (CMS) provides a standardized web-based provider training module through the Medicare Learning Network® (MLN) for both Medicare Parts C & D Fraud, Waste and Abuse (FWA) training and General Compliance training. All First Tier, Downstream and Related Entities are required to utilize this training to satisfy the regulatory requirements associated with FWA training and compliance training and education required under Medicare Parts C and D. Completed certificates or training logs must be made available for review, upon request. This training may be accessed through the following link: CMS FWA and General Compliance Training

How to Report Fraud, Waste, and Abuse

If you suspect fraud, waste, or abuse in the healthcare system, you must report it to Care N’ Care and we’ll investigate. Your actions may help to improve the healthcare system and reduce costs for our members, customers, and business partners.

To report suspected fraud, waste, or abuse, you can contact Care N’ Care in one of these ways:

Care N’ Care is a Medicare Advantage organization with a Medicare contract. Enrollment in Care N’ Care depends on contract renewal. You must continue to pay your Medicare Part B premium. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums and/or copayments/coinsurance may change on January 1 of each year. The Formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary. This information is available for free in other languages.
Care N’ Care Insurance Company, Inc. 1701 River Run, Suite 402, Fort Worth, TX 76107.